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Antidepressants Linked to Miscarriage Risk

Researchers See Possible Connection Between SSRIs and Miscarriages

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Miscarriage Risk continued...

Although any kind of exact biological mechanism remains unclear, Bérard says "it is believed that antidepressants have a mediated serotonin effect that would put pressure on the uterus at a very early stage of pregnancy."More research would be needed to flesh out any biological connection.

According to the researchers, antidepressants are widely used in pregnancy and up to 3.7% of women will use them at some point during the first trimester. However, discontinuing treatment can cause problems since depression can put both the mother and baby at risk. In the U.S., there are about 6 million pregnancies every year, and there are 2 million pregnancy losses including about 600,000 due to miscarriage in the first 20 weeks of gestation.

Second Opinion

In an accompanying editorial, Adrienne Einarson, assistant director of the Motherisk Program at The Hospital for Sick Children, writes that there is no "gold standard for studying the safety of drugs during pregnancy, because all methods have strengths and limitations." However, she notes she encountered similar findings in her own research. "Clearly, this study cannot make any definitive conclusions as to whether antidepressants increase the risk of spontaneous abortion."

David L. Keefe, MD, is a psychiatrist and chairman of the department of obstetrics and gynecology at New York University Langone Medical Center. Keefe cautions that there is no need to change treatment recommendations.

"The strength of the study is that it used a large sample size. The other strength is that they used a database to determine if women actually took the medication, so they didn't use individual recall, which can be biased," Keefe tells WebMD. "But they didn't control for the other factors that can also contribute to miscarriage."

Keefe says that women who use antidepressants tend to be older, smoke, and are obese, all factors that can contribute to miscarriage and also factors that may be seen among women with depression. "You need to control for age, smoking, and weight and then see if this association still holds up."

"The depression itself might increase the risk of miscarriage because of the stress on the body," he says. "This is the first paper I've seen to claim an association, but I'm not convinced. There's a lot more work to be done."